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9.15 pm
Mr. John Gunnell (Morley and Leeds, South): In closing this debate as far as Back Benchers are concerned, I should like to spend a minute or two binding together all the different issues in the motion. Any anecdote about the health service would be encompassed by the motion, but it is important to look at some of the principles that lie behind our criticisms of how it has operated under the Government. We are mounting what I regard as a principled critique of the health service, and it is important to place a few matters on record.
One factor that links the different parts of the motion is that we criticise the Government for showing a preoccupation with private provision. I shall give some examples. First, my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) referred to the commercialisation of the GP service. He was right to refer to the amendments tabled by the Minister for Health, which are to be found on pages 431-34 of today's Order Paper.
It is clear that the Minister has been at great pains to assure the British Medical Association that the National Health Service (Primary Care) Bill is not intended to pave the way for the commercialisation of GP services. It is obvious from comments in The Independent that the Minister's main concern is to ensure that this does not become an election issue. He has therefore two-timed the Committee that is considering the Bill. It is important that the Committee should discuss the Bill, but it is even more important to meet the BMA committee to sort out the minimum that it will settle for in order not to use its surgeries to campaign against the Tory party and the Government's record. That is why the Minister has tabled a sheet of amendments to the Bill.
My hon. Friend the Member for Islington, South and Finsbury was generous in saying that the Government had made mistakes and had got the matter wrong in the first place. They did not make mistakes; nor did they make mistakes the second time, when they again got it wrong in the eyes of the BMA--they were simply trying to get away with as much as possible in preparing for privatisation.
The second issue is the private finance initiative. I have no objection to the PFI per se. I agree with my party, which is about to support it. I have plenty of experience of working with private companies. The difficulty is that it is not possible to get any capital development without a PFI scheme.
A written answer that I received on Thursday from the Secretary of State listed 35 PFI schemes, of which 21 did not have a signed contract. I quite understand that businesses in the private sector do not want to sign contracts unless they are satisfied that they will return a profit--if they do not make a profit, they cannot expect to stay in existence for long; they have to make a profit. What is happening is that the NHS capital spend is determined by the rate at which the private sector signs up to schemes. That is taking the involvement of the private sector too far. There have to be some NHS-funded capital schemes.
Thirdly, and most important, is the issue of community care. I am very concerned at the plans for the privatisation of social services and community care. The Secretary of State, in his discussions with the Association of Directors of Social Services, made it clear that he sees social services not as a provider but as a purchaser of services. There are elements of the community care programme in which social services have to give 85 per cent. of the work to the private sector. The involvement of the private sector and the fact that the Government are trying at every level to push private provision is a matter of considerable concern that affects the future and quality of the service.
Many good things are happening in the NHS--I do not dispute that--but there is a gradual withdrawal by the Government from the fundamental principles on which the NHS was based. The NHS was founded on equity. My hon. Friend the Member for Islington, South and Finsbury gave the telephone patter that was to be given by Leeds general infirmary staff. The Secretary of State dismissed it as an anecdote. It was not. Throughout the country, trusts are finding that they cannot carry out operations at the moment because health authorities are out of money and they therefore have to concentrate on fundholders. That is a way of skewing the waiting list. It makes it longer. It also keeps some people off the waiting list for a few months, so they spend less time on it. There is a fundamental inequity of provision.
The NHS was intended to be free at the point of delivery, but increasingly we see charges. The service that is provided is on the basis of need, or should be, but it is very clear that that is not the only principle involved in the delivery of care.
A study carried out by the Joseph Rowntree Foundation said:
Mr. Tom Clarke (Monklands, West):
The comprehensive nature of our debate has confirmed the wisdom of my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) in presenting a motion dealing with health, community care and disability. Time after time we have been shown tonight that those issues relate to each other.
The debate was enhanced by the speeches of my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) and my hon. Friends the Members for Hemsworth (Mr. Trickett), for Liverpool, Broadgreen (Mrs. Kennedy), for Ellesmere Port and Neston (Mr. Miller)--who will soon have a new Labour neighbour--and for Morley and Leeds, South (Mr. Gunnell).
The debate has shown that, on disability policy, the British agenda has always been led by Labour. I am sorry that the hon. Member for Southwark and Bermondsey (Mr. Hughes) has not stayed to hear my speech, but perhaps he will read it tomorrow. Just as a Labour Government gave birth to the national health service, so a Labour Administration under Harold Wilson led the world on disability policy. My right hon. Friend the Member for Wythenshawe was the world's first disability Minister. He was a Labour Minister, and we are as proud of him tonight as we were throughout his years in government. He knew that, in the decade that began in 1970, we were setting an agenda of health, services and benefits for disabled people. His Chronically Sick and Disabled Persons Act 1970 was in its way revolutionary and must be revisited.
We moved on and, in the mid-1980s my Disabled Persons (Services, Consultation and Representation) Act 1986 excited the House. It was certainly fine that we managed to get the Bill through. I hope to return to that later in my speech. In the late 1980s and 1990s, the disability policy agenda moved further forward, and now we must move to tackle not just disadvantage, but discrimination.
It is Labour and, in fairness, other Opposition parties--but not the Conservatives--who have reflected the demand of disabled people for comprehensive and enforceable civil rights. A succession of Bills was presented by my right hon. and hon. Friends, and on a succession of Fridays hon. Members of all parties and all parts of Great Britain and Northern Ireland voted on them. We must also acknowledge that some Tory Back Benchers also supported our proposed legislation. So impressed were they that three of them crossed the Floor.
Civil rights for disabled people are not matters of dry legal entitlement or some formal claim to equal treatment. Disabled people are not just the stuff of political lobbying or pleading special interest: their rights constitute the vital, legitimate interests of more than 6 million of our fellow citizens. They relate to the blind boy who was about to leave school and who told me about being rejected at a job interview the moment the personnel manager saw his white stick although he could have done the job just as well as anybody else. They also relate to the woman who was refused admission to a cinema because she was in a wheelchair and the one space for a wheelchair in the cinema had been set aside for somebody else.
The debate is about the disabled citizens and voters, identified by Scope in its survey of the last general election, who were forced to vote in the streets because no one had thought to make polling stations accessible. In our nation, a disabled person is three times more likely to be unemployed, and six times more likely to be turned down for a job, than anyone else. The average income of disabled workers is just 80 per cent. of the national average income. If ever there was a case for the minimum wage that is it, and I proudly proclaim it.
The case involving ICI, which was brought to our attention by my hon. Friend the Member for Makerfield (Mr. McCartney), was a blatant example of disabled people being exploited, but we heard nothing from Conservative Members about it. In our nation, only one teacher in a thousand is disabled. That has many implications when we suggest that schools ought to be part of our community in every sense. There are only 80,000 accessible homes in Britain, but 4.25 million of our citizens have mobility-related impairments.
The Parliament began with the Government giving the impression that discrimination against disabled people did not exist. What we have witnessed since then does the Conservative party no credit either in the House or outside. The Berry Bill, as it was called, was piloted by my hon. Friend the Member for Kingswood (Mr. Berry) and was backed by a majority of hon. Members. The Government initially claimed that it would cost £17 billion--a ridiculous figure which they have never used again. We saw the disgraceful spectacle of the hon. Member for Sutton and Cheam (Lady Olga Maitland) and the right hon. Member for Chelsea (Sir N. Scott) talking out the Bill. The right hon. Member for Chelsea at least had the decency to apologise to the House.
It is no wonder that disabled people are cynical and sceptical about politicians when they are faced with the tawdry and dirty tactics of Conservative Members. It is no wonder that the recent MIND survey "Not Just Sticks and Stones" shows that the number of disabled people who blame politicians for the discrimination that they face is larger than the number who blame anyone else, including the people whom they encounter day by day. The Government talked out the Bill against the wishes of all Opposition parties.
The right hon. Member for Chelsea was made a scapegoat, and was relieved of ministerial office. He was replaced by the right hon. Member for Richmond, Yorks (Mr. Hague), who made an art form of wringing his hands with concern while washing them of responsibility. At least he was allowed to introduce legislation, which the right hon. Member for Chelsea was never permitted to do in six years in office. That was disgraceful. The Disability Discrimination Act 1995 came as a fig leaf to cover the Government's earlier embarrassment. It was a missed opportunity.
The Government were so terrified that a civil rights Act would eventually be passed that we were offered their tepid Bill, which was a fine example of legislation inspired by panic, not policy. Their White Paper failed even to mention education or transport. The Bill included rail stations and bus termini, but ignored trains and buses. It took a debate and a reasoned amendment on Second Reading for the Government to realise that they had forgotten to include provision for Northern Ireland.
The Act abolished the 3 per cent. employment quota and proclaimed to introduce in its place the right to equal treatment at work, but it excluded from that right disabled people working for smaller companies, which account for 94 per cent. of British firms. What a disgrace. The Government claimed that they wanted to outlaw discrimination, that the Act was sincere and well thought out, and that it was rooted in a genuine commitment to the 6.5 million disabled people who demanded full and comprehensive civil rights. However much the Tories patronise disabled people, their measures show that they view them as an irritation, and none of their legislation will be remembered.
In their amendment to the motion, the Government have the effrontery to compare themselves with other European Union nations. Have they considered the implications of their claims? Their amendment does not mention article 3 of the German constitution, which outlaws discrimination. It says:
I am surprised that the Government's amendment does not mention the Commission on the Status of People with Disabilities, established by the Government in Ireland, which, following extensive consultation, including more than 6,000 submissions, among other proposals, has recommended a fully fledged civil rights disability Act. The Irish Government expect to legislate this year.
Let us consider the Government's policy on mental health, community care and direct payments. Last year, I led for Labour on the Community Care (Direct Payments) Bill. Once again the Conservative Government were introducing a measure in response to demands from disabled people. Having accepted the principle that disabled people should be enabled to organise and pay for their own services by receiving direct payments, Ministers could not overcome their Conservative inclination to limit those new freedoms to as few people as possible. That is why at first they tried to exclude people with learning disabilities as if those service users were incapable of making an informed judgment about their own needs, no matter how well advised they were. The Government backed down on that, but as with civil rights and disability discrimination, they did so only because the parliamentary arithmetic forced their hand.
Above all, the Government refused to allow disabled people over 65 even to apply for direct payments, adding further to the disadvantage faced by older people. Even after the Government lost in Committee not once, but twice, on that issue, they insisted on excluding older disabled people from direct payments for the first 12 months. What utter meanness. They repeatedly rejected our arguments for creating a level playing field as between recipients of direct payments from local councils and recipients of independent living payments from the Department of Social Security, even though many people receive both.
The Government failed to take the opportunity to provide for registration of domiciliary care providers to meet the concern of disabled and elderly people about
establishing a common national standard for carers who work in people's homes. Disabled and elderly people are entitled to protection from society.
The Community Care (Direct Payments) Act 1996 was just one example of Tory mismanagement of community care, the Government's lack of commitment and understanding of measures that they have been forced into, and their failure to see them through.
The Government's mental health policy has been a complete failure. We all know of cases in our constituencies. Time and again we are faced with the evidence of a system that is failing. It cannot be right that nearly one third of NHS beds for people with mental health problems have been cut since 1989, yet we still await the appropriate community facilities. It cannot be right that for many people the first time their mental disability is recognised is when they are assessed by a prison medical unit. It cannot be right that only one in five people diagnosed as having schizophrenia and living in the community have access to a community psychiatric nurse. The Audit Commission concluded:
The Government's community care policy has provided inadequate care for those in need and inadequate protection for the general public. I am happy to congratulate the work of my hon. Friend the Member for Stockport (Ms Coffey). Her expertise and commitment are well known.
A new Labour Government will be committed to raising standards and ending the lottery in community care so that people have access to care regardless of where they live. As we have made clear many times, we shall establish a royal commission to work out a fair system for funding long-term care for elderly and disabled people. Nothing less will do. The cares identified by Sir Roy Griffiths have become greater still and invite support for that recommendation.
Mencap is particularly concerned about the treatment that people with learning disabilities receive in hospital. The recent community health report, "Hungry in Hospital" revealed that some people with learning disabilities were not eating while in hospital, as catering contractors were merely placing food in front of them without recognising their need for help. The report said that the uneaten food is cleared away at the end of the meal time, and that there is no follow-up action to establish why the food is not being eaten.
There is a great deal of anecdotal evidence, of which I am sure right hon. and hon. Members must be aware, of people with learning disabilities getting wrong or inappropriate treatment in hospital. In another case--[Interruption.] I do not see this as a source of amusement. In another case highlighted for me by Mencap, a young woman was sent home with an untreated broken leg because she could not explain the pain that she was in and the medical staff were not sufficiently trained to help her communicate effectively.
People with learning disabilities are often denied the full range of dental care.
I welcome the chance to look again at my Disabled Persons (Services, Consultation and Representation) Act 1986, remembering that, after much huffing and puffing, the Government finally backed down and the Bill became law. Half that Act is still to be implemented, which is absolutely shameful and, above all, a shameful disregard for legislation passed by the House. The National Health Service and Community Care Act 1990 provides only the right to assessment, and fails to ensure service provision. Our commitment to the agenda of health and social services is without question--and the people know it, as every opinion poll shows, and as I am sure we will see again on Thursday.
The Disability Discrimination Act 1995 was an opportunity missed. That is why a Labour Government will act quickly. We will create a disability rights commission in place of the two separate bodies that advise Ministers: the National Advisory Council on Employment of People with Disabilities and the National Disability Council. The commission will advise Ministers on a range of issues affecting disabled people. It will be encouraged to be proactive and not just a talking shop. It will work on what changes to the law are necessary and how we can best deliver full civil rights to all Britain's 6.5 million disabled people.
We will act on the commission and further initiatives in consultation with interested parties because we believe that employers, service providers and disabled people themselves should be fully involved in setting out the route that we should follow. In Northern Ireland, we will follow the same principles. I was delighted to visit the constituency of the hon. Member for Belfast, South (Rev. Martin Smyth) just a few weeks ago, and I welcome, too, his speech.
"Both health care and social care should be free at the point of delivery for all older people."
It also said:
"A complex funding system has shunted the costs of care from services which were free at the point of delivery to more means-tested provision."
24 Feb 1997 : Column 104
The Government have not only increased the amount of private provision but moved away from the fundamental principles on which the NHS was based.
9.23 pm
"Nobody shall be discriminated against because of a disability."
Their amendment does not mention the Danish equal opportunities centre for disabled persons, which was established in 1993 as a watchdog for disabled people, and can bring discrimination cases before the Danish authorities.
"Good comprehensive community care for people with mental health problems is slow to develop and its lack of implementation is causing major concern."
I trust that that is reflected in our considerations tonight.
"People like this do not take care of their teeth",
one mother was told. Her disabled son had his teeth extracted when a filling would have been sufficient. Such things are a disgrace to modern Britain and must be put right, but a new Labour Government will set our sights even higher and take our agenda one step further. We will demonstrate our commitment to health and social services, in contrast with the past miserable 18 years of Tory neglect.
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